Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke
Authors: Jie Shuai, Zili Gong, Li Huang, Juan Liu, Kun Tang, Zhenhui Duan, Houjie Ni, Yumin Liu, Fei Xie, Dongrun Yan, Songsheng Ye, Zhiquan Zhang, Zhihua Cao, Xianjin Shang, Xianhui Ding, Xiangjun Xu, Li Chen, Jiachuan Wu, Renliang Meng, Li Jiang, Yang Xie, Lei Lei, Libo Zhao, Tao Yu, Zhengjin Luo, Bin Li, Ning Wang, Jun Sun, Yong Liang, Zongqin Li, Xuejie Xu, Kangjia Song, Zeyu Hao, Chuanqing Yu, Xiaofei Zhou, Jing Zuo, Wenbin Wu, Xiyang Chen, Yaoyu Tian, Xiaogang Hu, Liang Wei, Xiuhua Wu, De’an Fu, Ce Han, Chunying Li, Yachun Liu, Chukai Xu, Shiyu Deng, Ling Fang, Gangfeng Gu, Rong Su, Jing Guo, Jing Wang, Minghua Cao, Mingchao Wu, Xuxu Wu, Yupeng Wu, Jisheng Qi, Da Liu, Wenkai Long, Yuxian Zhang, Mingshan Tang, Fei Zeng, Changya Liu, Tieyu Tang, Ying Yang, Yongliang Zhou, Dongzhang Xue, Ju Han, Jianhong Wang, Xuan Liu, Xu Zheng, Anding Xu, Guilian Zhang, Dong Yi, Yonggang Hao, Dan Liu, Min Lin, Fajin Lv, Chao Qin, Hua Yang, Zhongming Qiu, Fengli Li, Hongfei Sang, Weidong Luo, Shuai Liu, Wenhua Liu, Zhangbao Guo, Huagang Li, Dong Sun, Wenguo Huang, Min Zhang, Min Zhang, Weipeng Dai, Peiyang Zhou, Wei Deng, Zhiming Zhou, Xianjun Huang, Bo Lei, Jinglun Li, Zhengzhou Yuan, Bo Song, Jian Miao, Shudong Liu, Zhenglong Jin, Guoyong Zeng, Hongliang Zeng, Junjie Yuan, Changming Wen, Yang Yu, Guangxiong Yuan, Junxiong Wu, Chen Long, Jun Luo, Zhenxuan Tian, Chong Zheng, Zhizhou Hu, Shouchun Wang, Tao Wang, Li Qi, Rongzong Li, Yue Wan, Yingbing Ke, Youlin Wu, Xiurong Zhu, Weilin Kong, Jiacheng Huang, Daizhou Peng, Mingze Chang, Hanming Ge, Zhonghua Shi, Zhizhong Yan, Jie Du, Ying Jin, Dongsheng Ju, Chuming Huang, Yifan Hong, Tianzhu Liu, Wenlong Zhao, Jian Wang, Bo Zheng, Li Wang, Shugai Liu, Xiaojun Luo, Shiwei Luo, Xinwei Xu, Jinrong Hu, Jie Pu, Shengli Chen, Yaxuan Sun, Shunfu Jiang, Liping Wei, Xinmin Fu, Yongjie Bai, Shunyu Yang, Wei Hu, Guling Zhang, Chengde Pan, Shuai Zhang, Yan Wang, Wenfeng Cao, Shiquan Yang, Jun Zhang, Fuqiang Guo, Hongbin Wen, Jinhua Zhang, Jiaxing Song, Chengsong Yue, Linyu Li, Deping Wu, Yan Tian, Jie Yang, Mengjie Lu, Jeffrey L Saver, Raul G. Nogueira, Wenjie Zi, Qingwu Yang
Journal: JAMA (2022)

Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy.To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion.This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment took place between October 10, 2018, and October 31, 2021, with final follow-up on January 15, 2022.Participants received intravenous tirofiban (n = 463) or placebo (n = 485) prior to endovascular thrombectomy.The primary outcome was disability level at 90 days as measured by overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The primary safety outcome was the incidence of symptomatic intracranial hemorrhage within 48 hours.Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial. The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 (1-4) vs 3 (1-4). The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08 (95% CI, 0.86-1.36). Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3% [95% CI, -0.2% to 6.8%]).Among patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy, treatment with intravenous tirofiban, compared with placebo, before endovascular therapy resulted in no significant difference in disability severity at 90 days. The findings do not support use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke.Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167.